The Consequences of HLA Screening in the Prevention of Graft-Versus-Host Disease in Living Donor Liver Transplantation
Corresponding Author
Leman Damla Ercan
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Correspondence:
Leman Damla Ercan ([email protected])
Search for more papers by this authorÖzlem Durmaz
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorSabahattin Kaymakoğlu
Department of Internal Medicine (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorZerrin Önal
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorNesimi Büyükbabani
Department of Pathology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorMine Güllüoğlu
Department of Pathology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorAydın Alper
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorCem İbiş
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorSerdar Cantez
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorHacer Ayşen Yavru
Department of Anesthesiology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorFatma Savran Oğuz
Department of Medical Biology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorİlgin Özden
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorCorresponding Author
Leman Damla Ercan
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Correspondence:
Leman Damla Ercan ([email protected])
Search for more papers by this authorÖzlem Durmaz
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorSabahattin Kaymakoğlu
Department of Internal Medicine (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorZerrin Önal
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorNesimi Büyükbabani
Department of Pathology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorMine Güllüoğlu
Department of Pathology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorAydın Alper
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorCem İbiş
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorSerdar Cantez
Department of Pediatrics (Gastroenterology), İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorHacer Ayşen Yavru
Department of Anesthesiology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorFatma Savran Oğuz
Department of Medical Biology, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorİlgin Özden
Department of General Surgery, İstanbul Faculty of Medicine, İstanbul, Turkey
Search for more papers by this authorFunding: The authors received no specific funding for this work.
ABSTRACT
Aims
To study the effects of routine HLA screening and the policy of avoiding donor-dominant one-way HLA match to prevent graft-versus-host disease (GVHD) after living donor liver transplantation (LDLT).
Patients and Methods
The records of potential living liver donors and recipients who attended our center between 2007 and 2018 were reviewed retrospectively.
Results
Of the 149 patients who underwent LDLT and survived longer than 3 months, two developed GVHD despite our strict policy. The first patient presented with grade II GVHD limited to the skin. She was treated successfully by briefly discontinuing immunosuppression and switching to everolimus. In the second case, the policy had been relaxed due to the availability of a single donor for ABO-incompatible transplantation without any intervention to decrease anti-A antibody levels (special case: A2 to O). Nevertheless, the patient presented with grade I GVHD limited to skin and was treated successfully by adding oral methylprednisolone to tacrolimus and mycophenolate mofetil. To the best of our information, this is the second reported case who recovered from GVHD after LDLT from a donor, homozygous at HLA A, B and DR and a recipient, heterozygous for all. Sixteen potential donors (1.2% of all candidates) of 14 recipients were disqualified solely on the basis of the HLA results; five of these patients died due to unavailability of another donor.
Conclusion
The results support the policy of avoiding HLA combinations that preclude immune recognition of graft lymphocytes as foreign to decrease the risk of GVHD after LDLT.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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